tbuckley/cabot-search huggingface dataset:
Abstract P383: Trends in Multimorbidity Among U.S. Adults With and Without Hypertension, 1999-2000 to 2017-2020
Authors: Chibuike J Alanaeme, Oluwasegun P Akinyelure, Ying Wen, Ashley Christenson, Bharat Poudel, Shakia T Hardy, Kathryn Foti, Lama Ghazi, Christopher B Bowling, Michelle Long, Lisandro Colantonio, Paul Muntner
Journal: Circulation (2023)

Background: Most adults with hypertension have other chronic conditions. As obesity and diabetes are increasing among US adults, the prevalence of multimorbidity may have increased among US adults with hypertension. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) to assess the trend in multimorbidity among US adults (ages ≥ 20 years) with (n = 24,646) and without (n = 24,189) hypertension from 1999-2000 through 2017-March 2020. Hypertension was defined as systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥80 mm Hg, or use of antihypertensive medication. Multimorbidity was defined as the co-occurrence of ≥ 3 chronic conditions, not including hypertension. Chronic conditions were selected based on a framework from a US Health and Human Services report and data available in NHANES and included dyslipidemia, coronary heart disease, stroke, heart failure, diabetes, obesity, liver fibrosis, chronic kidney disease, asthma, lung disease (chronic obstructive pulmonary disease, emphysema, or chronic bronchitis), arthritis, hepatitis-C, cancer, and depression. Results: From 1999-2000 to 2017-2020, the age-adjusted mean number of chronic conditions increased from 2.4 to 3.0 among US adults with hypertension and from 1.9 to 2.2 among US adults without hypertension (Figure, top panel). During this period, the age-adjusted prevalence of multimorbidity increased from 42% to 56% among US adults with hypertension and from 32% to 34% among US adults without hypertension (Figure, bottom panel). In 2017-2020, after age, race/ethnicity, and sex adjustment, the mean difference in the number of chronic conditions among US adults with versus without hypertension was 0.70 (95% CI: 0.56 - 0.84). Multimorbidity was 1.50 (95% CI: 1.34 - 1.68) times more common among US adults with versus without hypertension. Conclusion: Multimorbidity has increased among US adults, and its prevalence is higher among adults with versus without hypertension.
Abstract 58: Timing of Outpatient Postpartum Care Utilization Among Women With Chronic Hypertension and Hypertensive Disorders of Pregnancy
Authors: Jasmine K Aqua, Nicole D Ford, Elena V Kuklina, Donald K Hayes, Adam S Vaughan, Fátima Coronado
Journal: Circulation (2023)

Objectives: The postpartum period represents an opportunity to intervene on the cardiovascular health of women who experience chronic hypertension in pregnancy or hypertensive disorders of pregnancy (HDP), including gestational hypertension, preeclampsia or eclampsia, and chronic hypertension with superimposed preeclampsia. This study sought to determine whether women who experience chronic hypertension or HDP access timely postpartum care compared to women with no documented hypertension. Methods: We used insurance claims data from the IBM MarketScan® Commercial Claims and Encounters Database. We included n=274,714 women 12-55 years old with a delivery hospitalization between 2017-2018 with continuous insurance enrollment from 3 months before the estimated start of pregnancy to 6 months after delivery discharge. Chronic hypertension and HDP were identified using International Classification of Diseases 10th Revision Clinical Modification codes. Distributions of time-to-event survival curves (time to first outpatient postpartum visit with a women’s health, primary care, or cardiology provider) were compared between the hypertension types using Kaplan-Meier estimators and logrank tests. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Time points of interest (3, 6, and 12 weeks) were consistent with visit benchmarks in traditional and updated postpartum care guidelines. Results: The prevalences of HDP, chronic, and no documented hypertension were 11.7%, 2.6%, and 85.7%, respectively. The proportions of women with a visit within 3 weeks of delivery discharge were 28.0%, 26.8%, and 15.8% for HDP, chronic, and no documented hypertension, respectively. By 12 weeks, the proportions increased to 59.6%, 61.3%, and 51.5%, respectively. Kaplan-Meier analyses indicated significant differences in utilization by hypertension type and interaction between hypertension type and time before and after 6 weeks. In adjusted Cox proportional hazards models, the utilization rate before 6 weeks among women with HDP was 1.42 times the rate for women with no documented hypertension (aHR=1.42, 95% CI: 1.40, 1.45). Women with chronic hypertension had similarly higher rates compared to women with no documented hypertension (aHR=1.29, 95% CI: 1.24, 1.35). There were no significant associations by hypertension type after 6 weeks. Conclusions: Women with HDP and chronic hypertension attend outpatient postpartum care visits faster than women with no documented hypertension. However, there were no significant associations by hypertension type after 6 weeks due to interaction with time before and after the traditional 6-week visit. Overall, utilization remains low in all groups. Addressing barriers to postpartum care attendance can ensure timely care for women at high risk for cardiovascular disease.
Abstract P247: Factors Associated With the Severity of the Hypertensive Disorders of Pregnancy
Authors: Matthew S Loop, Rachel P Urrutia, Jasmine D Johnson, Thomas M Price, Tracy Y Wang, Melissa A Daubert
Journal: Circulation (2023)

Objective: Hypertensive disorders of pregnancy (HDP) are a spectrum of disorders with increasing severity: gestational hypertension, preeclampsia, preeclampsia superimposed on chronic hypertension, and severe preeclampsia/eclampsia. Although factors associated with developing an HDP have been established, it is unclear which factors are associated with more severe HDP. This study aimed to estimate the associations between clinical, demographic, and social factors and severity of HDP. Methods: We conducted a retrospective, cross-sectional study of electronic medical records of women who delivered between 2014 and 2017 at two academic medical centers and were diagnosed with an HDP during pregnancy or up to 6 weeks postpartum. Patients were categorized by highest severity of HDP. We used ordinal logistic regression models to estimate odds ratios (ORs) for the severity of HDP by covariates including demographic data and clinical characteristics. Results: Among 5,607 women diagnosed with an HDP, 2,609 (47%) had gestational hypertension, 1,748 (31%) had preeclampsia, 608 (11%) had preeclampsia superimposed on chronic hypertension, and 642 (11%) had severe preeclampsia/eclampsia. Median (Q1, Q3) maternal age was 30 (25, 34) years; 46% (2,588 of 5,607) were white race, 32% (1,811 of 5,607) were black race, and 22% were other race (1,208 of 5,607); 15% (822 of 5,607) were Hispanic/Latina; 13% (735 of 5,607) had gestational diabetes; 42% (2,351 of 5,607) received care at institution A, 44% (2,445 of 5,607) at institution B, and 14% (811 of 5,607) at both; median (Q1, Q3) maternal body mass index near delivery was 35(30, 41) kg/m^2; and median (Q1, Q3) household income of ZIP code of residence was $50,734 ($43,592, $69,380). Factors independently associated with more severe HDP (OR, 95% CI) included: older maternal age (1.15 per 10-year increase, 1.05 - 1.27), Black race (1.48, 1.3 - 1.68) versus white, Hispanic/Latina ethnicity (1.51, 1.22 - 1.88), gestational diabetes (1.35, 1.16 - 1.65), and receiving care at institution A vs B (1.23, 1.1 - 1.38) or both institutions vs institution B (1.32, 1.13 - 1.54). Maternal body mass index near delivery (0.98 per 10 kg/m^2 increase, 0.92 - 1.05) was not meaningfully associated with more severe HDP. Conclusions: Several factors were associated with more severe HDP. Importantly, these factors may help identify women who are at a higher risk for developing a more severe form of HDP. Further study is needed to confirm these findings and determine interventions that can mitigate risk to improve women’s cardiovascular health.
Abstract P110: Hypothalamic Amenorrhea Phenotype and Cardiovascular Disease Risk
Authors: Jennifer J Stuart, JoAnn E Manson, C. Noel Bairey Merz, Kenneth J Mukamal, Kathryn M Rexrode, Janet W Rich-Edwards, Chrisandra L Shufelt
Journal: Circulation (2023)

Introduction: Hypothalamic amenorrhea (HA) is a neuroendocrine disorder characterized by ovulatory dysfunction, anovulation, and infertility, which can be prolonged for months to years. Menstrual cycle irregularity and amenorrhea identify individuals with higher CVD risk, but existing evidence has not examined HA separately from polycystic ovary syndrome (PCOS). It remains unknown whether HA is associated with CVD events across the lifecourse. Hypothesis: We hypothesized that the HA phenotype (oligo/amenorrhea without PCOS traits) would identify individuals at increased risk for CVD. Methods: Nurses’ Health Study II participants with available information on menstrual cycle characteristics who were premenopausal and free of CVD at baseline comprised the analytic sample (n=83,281). Menstrual cycle regularity was retrospectively reported for ages 18-22y on the baseline questionnaire in 1989 while the 1993 biennial questionnaire captured current menstrual cycle regularity (at ages 29-49y); PCOS traits (severe acne, hirsutism) were additionally ascertained in 1993. Participants were followed for confirmed incident CVD (MI, stroke, and fatal CHD) from 1993 through 2017. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for the relationship between HA and CVD, adjusted for age, race/ethnicity, parental education, parental history of CVD &lt;60y, and behavioral risk factors (smoking, physical activity, diet, alcohol intake, body mass index). Results: Thirteen percent of participants (n=11,071) ever had HA: 8.5% of participants (n=7,081) had HA at ages 18-22y while 6.5% (n=5,428) had HA at ages 29-46y. Persistent HA (HA at both 18-22y and 29-46 y) was identified in 1.7% of participants (n=1,438). CVD events occurred in 253 individuals who ever had HA (HA at either 18-22y or 29-46y) and 1,228 individuals without the HA phenotype. Individuals who ever had HA had a 20% higher rate of CVD (CI: 1.05-1.38). HA phenotype at ages 18-22y was not associated with CVD risk (HR=1.14; CI: 0.96-1.35) while HA phenotype at ages 29-46y was associated with a 30% higher rate of CVD (CI: 1.10-1.54) compared to individuals without HA phenotype. Individuals with persistent HA across both age ranges had a 69% higher rate of CVD (CI: 1.24-2.28). Underlying associations were strongest between ever HA and stroke (HR=1.25; CI: 1.03-1.51) and between persistent HA and CHD (HR=1.90; CI: 1.27-2.86), although case counts were small. Conclusions: HA phenotype in mid-adulthood identified individuals at increased risk of CVD compared to those without HA. As there are multiple HA subtypes, defined by varying combinations of psychosocial stress, anxiety, physical activity and weight loss, future studies should examine which HA subtypes are associated with CVD risk.
Abstract P129: Age at Menarche Associated With Cardiovascular Disease Risk Factors and History Among African American Women: The Jackson Heart Study
Authors: Katelyn Jackson, Benjamin Walker, Elizabeth Heitman, Nelson Atehortua De la Peña, Jennifer Reneker
Journal: Circulation (2023)

Menarche is the onset of menstruation and is a definitive indication of female puberty. The average age at menarche has steadily declined worldwide over the past century. While many cardiovascular conditions have their start during youth, age at menarche may also play a role in predicting the risk for cardiovascular disease (CVD). Of particular importance is the disproportionately high number of CVDs that affect African Americans, which contributes greatly to the disparities in life expectancy between African Americans and Whites. This study aims to address a gap in knowledge about African American women’s health by examining the association between age at menarche and CVD. We assessed the hypothesis that an earlier age at menarche is associated with increased odds of CVD risk factors and history for women in the Jackson Heart Study. This study was a secondary analysis of baseline data from 2,458 females in the Jackson Heart Study, a longitudinal cohort study of African Americans in the Jackson, MS metropolitan area. Early menarche was defined as menarche occurring at less than 12 years of age. Cardiovascular disease risk factors included hypertension, diabetes, obesity, and abdominal obesity (waist circumference &gt;88cm). Cardiovascular disease history included coronary heart disease, heart attack, and stroke. The association between early menarche and CVD risk factors and history was examined using multivariable logistic regression models, controlling for physical activity, nutrition, smoking, alcohol use, education, income, and oral contraceptive use. The prevalence of CVD risk factors and CVD history was higher for women with an early age at menarche (&lt;12 years) than for other women. After adjusting for covariates, early age at menarche was associated with greater odds of hypertension (OR, 1.47 [95% CI, 1.17-1.84]), obesity (OR, 1.77 [95% CI, 1.43, 2.19]), abdominal obesity (OR, 1.87 [95% CI, 1.44, 2.41)], history of coronary heart disease (OR, 1.98 [95% CI, 1.33, 2.94]), and history of heart attack (OR, 1.76 [95% CI, 1.09, 2.84]). Early age at menarche was not significantly associated with diabetes or stroke history. In conclusion, in this large sample of African American women in the Jackson Heart Study, we observed that menarche before 12 years of age was associated with increased odds of CVD risk factors and CVD history compared to those with menarche after 12 years of age. These findings highlight the importance of exposures during youth and childhood which may contribute to poor health outcomes in later life.
Abstract P228: Accelerometer-Derived Daily Steps, Cognition, and Cognitive Impairment in U.S. Community-Dwelling Older Adults: The Atherosclerosis Risk in Communities Study
Authors: Pablo Martinez-Amezcua, Erin Dooley, Lisa Pompeii, Kelly R Evenson, Brady Rippon, B Gwen Windham, Thomas Mosley, Jennifer Schrack, Kelley P Gabriel, Priya Palta
Journal: Circulation (2023)

Introduction: Higher physical activity levels have been shown to preserve cognitive function and prevent cognitive impairment (CI). Whether daily steps, an easily interpretable physical activity metric, is associated with measures of brain health has not been widely studied. Hypothesis: Higher daily step count is associated with better cognitive function and lower odds of CI. Methods: Cross-sectional analysis of ARIC participants (mean age: 78 years, 41% male, 19% Black) who wore an accelerometer (ActiGraph GT3X) on the waist for ≥10 hours on ≥3 days between 2016-17. Daily steps were derived and examined continuously and by quartiles. Global and domain-specific (memory, language, executive function) factor scores were estimated from a battery of cognitive tests. Participants were classified as having CI if they had an adjudicated diagnosis of mild CI or dementia. Hypotheses were tested using linear and logistic regression models, adjusted for age, sex, race, education, and accelerometer wear time. Results: Among 454 participants, 88 (19.4%) had CI. The mean number of daily steps was 3,501 (SD=1,974). In adjusted models, a higher daily step count was associated with better global cognition and executive function factor scores (e.g., those in the 4 th daily-step quartile [≥4,499 steps] vs. 1 st [&lt;2074 steps] had a 0.43 [95% confidence interval: 0.24 to 0.61] higher executive function score). Associations of step count with memory or language scores were not supported. The odds of CI were lower for participants who had a higher daily steps count (e.g., those in the 4 th daily-step quartile vs. 1 st had 62% [odds ratio (OR)=0.38, 95% confidence interval: 0.16 to 0.90] lower odds of CI. The OR of CI for continuous daily steps shown in the Figure. Conclusions: Higher daily steps were associated with better cognitive function and may be a helpful marker in identifying participants with CI. Prospective studies of accelerometer-measured physical activity and cognitive outcomes are needed to understand the direction of these associations.
Abstract P370: Implicit Bias Among Vascular Surgeons
Authors: Corey A Kalbaugh, Kerry Howard, Brian Witrick
Journal: Circulation (2023)

Objective: Implicit bias is an unconscious bias that may influence behavior, cognitive processes and decision-making. In clinical settings, implicit bias present in clinicians may influence the treatment that people receive and may be a root cause of health disparities. Our study measured implicit bias among vascular surgeons who participate in the management of individuals with peripheral artery disease (PAD). Methods: Our sampling frame included all vascular surgeons that contribute to the Vascular Quality Initiative (VQI) registry. We invited these individuals to take the race implicit association test (IAT) used to measure level of unconscious bias. The IAT asks participants to classify items presented on a computer by quickly pressing computer keys. The underpinning of the IAT is that people will match a representative group (images of African American or European American faces) to an attribute (good and bad words, such as excellent and angry) more quickly if there is already an implicit connection. Based on the differences in reaction time from several trials, participants are classified as having a no preference between African American and European Americans or a preference for one or the other. The level of preference can be slight, moderate, or strong. We stratified implicit findings by physician race/ethnicity. Results: Among 2765 vascular surgeons that participate in the VQI, 338 (12%) completed the IAT. Most participants (70%) showed an automatic preference for European Americans over African Americans, with more than half of participants (51%) showing a moderate or strong automatic preference. Of 195 participants who identified as Non-Hispanic White, 25% showed a slight automatic preference for European Americans, 41% showed a moderate automatic preference, and 34% showed a strong automatic preference. Of 16 participants who identified as Non-Hispanic Black, 38% showed an automatic preference for European Americans over African Americans and 31% showed an automatic preference for African Americans. We also found that participants were often unaware of their biases: More than two-thirds (n=64) of the 94 participants who disagreed with a statement asking if they are biased (“I am biased”) had an automatic preference upon testing. Conclusions: Implicit bias was found among vascular surgeons. The next step in our research will focus on the ability of implicit bias scores to predict a surgeon’s actual delivery of guideline care. Pending our findings, training and clinical support tools offer techniques to mitigate the impact of implicit biases on PAD-related health care.
Abstract P548: Epigenome-Wide Association Meta-Analysis of Obesity in African Americans
Authors: Kendra Ferrier, Ethan Lange, Jerome I Rotter, Stephen S Rich, David van der Berg, Silva Kasela, Leslie Lange
Journal: Circulation (2023)

Background: Despite considerable advances in obesity genetics, much remains to be learned regarding the pathway from genes to obesity development. Prior studies have shown that that 40-70% of the variation in body mass index (BMI), a measure of obesity, is due to heritable factors, yet BMI-identified genetic variants only account for a limited portion of the heritability. Research suggests epigenetic variation, which reflects both genetic and environmental influence, may account for some of the missing heritability. However, such studies have largely been conducted in primarily European ancestry populations, despite the disproportionate burden of obesity in African Americans (AAs). Methods: To identify CpG sites associated with BMI in AAs, we conducted an epigenome-wide association study (EWAS) using participants from the Jackson Heart Study (JHS, n=1604) and a subset of AA participants from the Multi-Ethnic Study of Atherosclerosis (MESA, n=179) using the Illumina HumanMethylationEPIC array (~850K CpG sites). Analyses were stratified by study and sex and meta-analyzed using an inverse-variance weighted approach. EWAS was performed using a linear regression model with methylation M-values (n=573,388 CpGs) as the outcome and continuous BMI as the predictor. Covariates in the linear models included age, centered-mean-age-squared, smoking status (never/past/current), 10 genetic ancestry principal components, and Houseman-estimated blood cell proportions. Results: The meta-analysis resulted in 204 CpGs that reached epigenome-wide significance (p &lt; 8.72 x 10 -8 ) after multiple-testing correction, and these include both previously identified and novel BMI-associated sites. 48 of the 204 have been previously reported in EWAS of obesity phenotypes, 11 of which were in studies of AAs. 156 of the methylation sites significantly associated with BMI in this study are novel, and potentially AA-specific. Differentially methylated region (DMR) analysis showed significant association of these CpGs in the promoters of genes previously associated with obesity traits, such as SOCS3, ABCG1, and TGFB1 , although TGFB1 had not previously been associated in AAs. In addition, the DMR analysis revealed novel obesity-associated CpGs in genes, including JAK3, which has previously been shown to have differential gene expression in association with BMI in MESA. Conclusion: We identified novel, potentially AA-specific, methylation sites associated with BMI in the largest African-ancestry EWAS conducted thus far, supporting that continued analysis in diverse populations is crucial for increased understanding of obesity.